Question 1

How do I enable APCM documentation features in athenaOne?

Accepted Answer

To document APCM effectively, you must configure the Care Management module to include specific templates for chronic care assessment. You should also create custom macros in athenaOne to speed up the documentation of care coordination activities, ensuring all CMS-required elements like care plan updates are captured.

Question 2

Can I create custom encounter types for APCM in athenahealth?

Accepted Answer

Yes, setting up specific encounter types for G0556, G0557, and G0558 allows for cleaner tracking and prevents these interactions from being confused with standard E/M visits. This helps in auditing your APCM program and ensures that the time spent on non-face-to-face care is accurately logged.

Question 3

How do we handle the required 24/7 access documentation in athena?

Accepted Answer

APCM requires 24/7 access to the care team. By integrating AI call handling with athenahealth, every after-hours interaction is automatically summarized and logged into the patient's chart as a 'Phone Note' or 'Task', providing a clear audit trail of compliance with this CMS mandate.

Question 4

Where should I store APCM patient consent forms in athenahealth?

Accepted Answer

Patient consent should be uploaded to the 'Patient Documents' section using a specific document class, such as 'Consent - APCM'. Alternatively, you can use a custom 'Global Observation' field to track the date consent was obtained, making it easily pullable for reporting and billing verification.

Question 5

How are APCM codes G0556, G0557, and G0558 configured in athena billing?

Accepted Answer

You must add these codes to your athenahealth Fee Schedule and link them to the appropriate primary care providers. Ensure that the billing rules engine is updated to check for the presence of the required chronic condition ICD-10 codes before the claim is scrubbed and sent to the clearinghouse.

Question 6

Does athenahealth automatically check for APCM billing conflicts?

Accepted Answer

While athena provides standard claim scrubbing, you should work with your CSC to build custom claim edits that flag if an APCM code is billed alongside CCM or PCM codes in the same month, as this is generally prohibited under CMS guidelines for the same patient.

Question 7

What documentation is required to support a G0556 claim in athena?

Accepted Answer

Documentation must include a comprehensive care plan, evidence of patient consent, and a record of the care coordination activities. In athenaOne, these are best managed through the 'Care Plan' tab and the 'Clinical Lead' dashboard to ensure all compliance checkboxes are hit before billing.

Question 8

How do I handle APCM claim denials in athenaNet?

Accepted Answer

Use the 'Claim Edit' and 'Denial Management' dashboards in athenaNet to identify specific rejection reasons. Common issues include missing modifiers or lack of documented chronic conditions; these can be resolved by refining your athena documentation templates to include mandatory fields.

Question 9

How do I build a report in athenahealth to identify APCM-eligible patients?

Accepted Answer

Utilize the 'athenahealth Report Builder' to filter your patient population by those with two or more active chronic conditions and specific insurance types. You can export this list to prioritize outreach for patients who meet the clinical criteria for G0556-G0558 codes.

Question 10

Can I use athenahealth Population Health for APCM tracking?

Accepted Answer

Yes, the Population Health module is ideal for APCM. It allows for advanced stratification and risk scoring, helping your care managers identify which patients require the most intensive coordination, which is a core component of high-level APCM reimbursement.

Question 11

How do I track which patients have provided verbal vs. written consent?

Accepted Answer

Create a custom 'Patient Attribute' or use a specific note type in the social history section of athenaOne. This allows you to generate a report showing which patients are fully enrolled and which are still pending documentation, ensuring you don't bill prematurely.

Question 12

What is the best way to monitor APCM enrollment growth in athena?

Accepted Answer

Configure a custom dashboard in 'athenahealth Analytics' that tracks the volume of APCM G-codes billed per provider. This gives you real-time visibility into the financial health of your care management program and helps identify providers who may need more support.

Question 13

How does AI call handling integrate with athenahealth for APCM?

Accepted Answer

AI call handling systems use the athenahealth API to securely access patient lists and schedule follow-ups. When the AI speaks with a patient, it can automatically create a 'Phone Note' in athenaOne, documenting the encounter for compliance without manual data entry from your staff.

Question 14

Can AI automate the initial APCM enrollment call for athena practices?

Accepted Answer

Absolutely. AI can handle the high-volume outreach required to explain the benefits of APCM to eligible patients identified in your athena reports. It can capture verbal consent and immediately trigger a task for the clinical team to finalize the care plan in athenaOne.

Question 15

How are AI-handled after-hours calls documented in athenaOne?

Accepted Answer

The AI generates a structured summary of the patient's needs and logs it directly into the athena clinical inbox. This ensures that the 24/7 access requirement of APCM is met while providing the physician with actionable data the next morning.

Question 16

Can AI verify insurance eligibility for APCM before the outreach call?

Accepted Answer

Yes, by integrating with athena's real-time eligibility (RTE) engine, the AI can confirm that a patient has active coverage that supports APCM billing before initiating the call, preventing wasted outreach efforts and ensuring billing accuracy.

APCM Compliance & Documentation Guide for Athenahealth

athenaOne Configuration & Setup

Billing & Claim Submission (G0556-G0558)

Eligibility & Reporting

AI Automation & Patient Outreach

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